Furosemide is associated with acute kidney injury in critically ill patients

Abstract

Acute kidney injury (AKI) is common in critically ill patients. Diuretics are used without any evidence demonstrating a beneficial effect on renal function. The objective of the present study is to determine the incidence of AKI in an intensive care unit (ICU) and if there is an association between the use of furosemide and the development of AKI. The study involved a hospital cohort in which 344 patients were consecutively enrolled from January 2010 to January 2011. A total of 132 patients (75 females and 57 males, average age 64 years) remained for analysis. Most exclusions were related to ICU discharge in the first 24 h. Laboratory, sociodemographic and clinical data were collected until the development of AKI, medical discharge or patient death. The incidence of AKI was 55% (95%CI = 46-64). The predictors of AKI found by univariate analysis were septic shock: OR = 3.12, 95%CI = 1.36-7.14; use of furosemide: OR = 3.27, 95%CI = 1.57-6.80, and age: OR = 1.02, 95%CI = 1.00-1.04. Analysis of the subgroup of patients with septic shock showed that the odds ratio of furosemide was 5.5 (95%CI = 1.16-26.02) for development of AKI. Age, use of furosemide, and septic shock were predictors of AKI in critically ill patients. Use of furosemide in the subgroup of patients with sepsis/septic shock increased (68.4%) the chance of development of AKI when compared to the sample as a whole (43.9%)

The effect of low-dose furosemide in critically ill patients with early acute kidney injury: A pilot randomized blinded controlled trial (the SPARK study)

“…The necessity for additional clinical trials specifically focused on unraveling the optimal use, efficacy and safety of furosemide in AKI stems from an apparent disconnect in the widespread utilization of furosemide in practice juxtaposed with evidence suggestive of no clinical benefit and potential harm [5,[31][32][33]. Early clinical trials of furosemide use in AKI were small, confounded by co-interventions (i.e., mannitol, dopamine), characterized by late administration…”

Prophylactic furosemide infusion decreasing early major postoperative renal dysfunction in on-pump adult cardiac surgery: a randomized clinical trial

“…Nuutinen and Tuononen12 reported that the prophylactic use of furosemide infusion had a beneficial impact on renal function in cardiac surgery, other studies, however, could not support this finding 2,13. Only a few studies supported the efficiency of furosemide, and some evidence has even indicated its disadvantages 2,13–15. In a double-blind, randomized, controlled trial, Lassnigg et al2 reported that furosemide might even potentiate renal dysfunction after cardiac surgery.…”

Massive Proteinuria-Induced Injury of Tubular Epithelial Cells in Nephrotic Syndrome is Not Exacerbated by Furosemide

“…However, a series of studies suggested that furosemide may be a potential nephrotoxic drug. Furosemide, when combined with gentamicin [2], cephalosporin [3, 4], or vancomycin [5], augmented nephrotoxicity. Furthermore, it has been shown that forced diuresis with furosemide is associated with a higher risk of contrast-induced nephropathy [6].…”

“…Recent reports also indicate that furosemide is associated with acute kidney injury (AKI). When used in adult patients in an intensive care unit (ICU) setting [7, 8], or in patients in pediatric ICU [9], furosemide increased the risk of AKI. These studies together suggest that furosemide may be a potential nephrotoxic drug that when combined with other renal injury factors, increases the risk of kidney injury.…”